Transcript Document

California State University, Bakersfield
Department of Nursing
Required Student Hospital
Education Program
Revised 3/23/10
LOCAL HEALTHCARE FACILITY
ORIENTATION
Adapted from Adventist Health,
Catholic Healthcare West, Delano
Regional Medical Center, Kern Medical
Center, Bakersfield Heart Hospital
Orientation Programs
Integrity
Standards of Conduct
Patient Rights
Hospital Compliance Functions
What is the purpose of the Integrity
Program?
 Reinforces commitment to being a values-based
organization.
 Demonstrates commitment to ethical conduct.
 Provides us with guidelines.
 Assists in identifying strengths and weaknesses
in our systems.
 Provides a structure through which problems
can identified and corrected.
 Decreases risk of regulatory violations.
Elements of Integrity Program
Standards of Conduct and Policies /
Procedures
The Regulatory Compliance Function /
Management Accountability
Education Opportunities Reporting
Systems
Auditing and Monitoring Processes
Exclusion Screening Process
Corrective Action
Standards of Conduct
The Standards of Conduct are the
foundation of the Integrity Program.
All students are to follow the Standards
of Conduct.
Standards of Conduct
 Patient Rights
 Appropriate Care and Treatment
 Emergency Services
 HIPAA
Patient Rights
 Appropriate Care and Treatment
Patients are treated at all times with care, concern
and respect.
Medically necessary care is provided to patients
conditioned on informed consent.
Patients are informed of their right to self determination.
Medicare beneficiaries are given appropriate notices.
Patients are provided information at discharge of post
- hospital services they require.
A patient’s special needs are considered.
Patient Rights
Emergency Services
Regardless of ability to pay, patients are
provided:
Medical Screening Examination, within the
capacity of the facility;
Stabilizing treatment; and
Appropriate transfer, if necessary.
Standards of Conduct
Ethical Conduct
Local hospitals are committed to the highest
standards of business ethics and integrity.
Honest Communication
Misappropriation of Proprietary Information
Confidential Information
Conflict of Interest
Gifts, Gratuities, Entertainment and Honoraria
Respect and Integrity
Standards of Conduct
Fiscal Responsibility
All hospitals maintain a financial statement
that properly represent its financial position,
results of operations and cash flow in
conformity with accepted practice.
Standards of Conduct
Laws and Regulations
Hospitals must comply with all laws and
regulations affecting its business:
•
•
•
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•
Medicare / Medicaid
Anti - Kickback
Self - Referral (Stark)
Taxes
Private Benefits
• Lobbying and Political
Contributions
• Antitrust
• Employment
• Physician Relations
• Health and Safety
Standards of Conduct
Laws and Regulations
All health care facilities and entities are required to:
Maintain honest and accurate records concerning
the provision of health care services;
Submit accurate claims;
Never offer, pay, solicit, or receive any money, gifts
or services in return for the referral of patients or to
induce the purchase of items or services; and
Document services provided accurately and
completely.
The Hospital Compliance Functions
Compliance resources include the:
 Compliance Officer;
 Compliance Oversight Committees;
A variety of other resources which support
compliance efforts.
Reporting Systems
Manager / Supervisor
Human Resources
Facility Compliance Liaison
Compliance Hotline – Office of
Inspector General (OIG)
Hospital E.O.C. / Safety
Orientation
Hospital E.O.C. / Safety
Orientation
Environment of Care Management Plans
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1. Safety Management Plan
2. Fire Safety Management Plan
3. Medical Equipment Management Plan
4. Utilities Management Plan
5. Disaster Preparedness Management Plan
6. Hazardous Waste and Materials Management Plan
7. Security Management Plan
Emergency Hospital Codes
Bakersfield Memorial Hospital
 Code RED
 Code BLUE
 Code
WHITE
 Code YELLOW
 Code GRAY
 Code SILVER
 Code PINK
 Code PURPLE
 Code ORANGE
 Code Triage Internal
 Code Triage External
Fire Emergency
Adult Cardiopulmonary Arrest
Child Cardiopulmonary Arrest
Bomb Threat
Combative Person
Person with a weapon &/or
hostage situation
Infant Abduction
Child Abduction
Hazardous Material
Spill/Release
Internal Disaster
External Disaster
Hospital Emergency Codes
Mercy Hospital/Mercy Southwest Hospital
 Code
 Code
 Code
 Code
 Code
 Code
 Code
 Code
 Code
RED
BLUE
GREEN
SILVER
PINK
YELLOW
WHITE
Weapon in the Workplace
TRIAGE EXTERNAL
Community Based Disaster
Fire Emergency
Medical Emergency / Arrest
Workplace Violence Response
Infant / Child Abduction
Chemical Spill / Hazmat Alert
Bomb Threat Alert
TRIAGE INTERNAL Structural
Damage
Hospital Emergency Codes
Adventist Health
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Code White
Code YELOW
Code Blue
Code ORANGE
Code RED
Code Purple
Code Pink
Code GRAY
Code Silver
 Code Triage Internal
 Code Triage External
Medical Emergency - Pediatric
Bomb Threat
Medical Emergency- Adult
Hazardous Material Spill/Release
Fire
Child Abduction
Infant Abduction
Combative Person
Person w/ weapon or Hostage
Situation
Internal Disaster
External Disaster
Hospital Emergency Codes
Delano Regional Medical Center
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Code Rapid
Code "D“
Code "K“
Code Red
Code Blue
Code Green
Code White
Code Pink
Code Yellow
Code Purple
Code Gray
Code Helicopter
Code Orange
Respiratory Emergency
Disaster Emergency
Kidnapping (Child or Adult)
Fire Emergency
Cardiac Arrest
Security Emergency
Hospital Lockdown
Infant Abduction
Bomb Threat
Patient Assistance
Hostage Situation
Helicopter Landing
Bio-Terrorism Emergency
Emergency Hospital Codes
Bakersfield Heart Hospital
Code Blue
Code Green
Code Red
Code Yellow
Code Black
Code Silver
Respiratory/Cardiac Arrest
Combative Situation
Fire Emergency
Disaster Alert (Standby)
Disaster Plan in Effect
Situation Involving a Gun
Adventist Health – Color Coded Wristbands
 Effective June 15, 2009, SJCH will implement the Color Coded
Wristband Policy. All RNs have been assigned to complete an
education module on this in HealthStream.
 What does this mean to non-nursing staff?
 All patients (in-patient and outpatient) will be assessed by their RN for
Allergies, Fall Risk and Code status (maximum, directed or comfort
code).
 Patients with known allergies will have a RED ALLERGY alert clasp
attached to their blue wrist band
 Patients assessed to be a fall risk will have a YELLOW FALL RISK alert
clasp attached to their blue wrist band
 Patients with a physician’s ORDER on their chart for a COMFORT
CODE will have a PURPLE DNR alert clasp attached to their blue wrist
band
 ONLY the RN may apply or remove the color coded wrist band alert
clasps
 Any time you have to remove or replace a patient’s wrist band for any
reason, or it falls off, or you notice a patient without their wrist band,
your responsibility is to notify the patient’s RN so the band can be reapplied and the patient assessed for the needed alert clasps ~ ASAP.
We share the job of keeping all of our patients safe.
Adventist Health – Color Coded Wristbands
Below is a picture of what each alert
clasp looks like. Be aware of these
when performing any patient
interventions.
Emergency
Phone Numbers
 Bakersfield Memorial Hospital – Dial 77, Dial 70 for Security
 Kern Medical Center – Dial 5#
 Mercy Hospital & Mercy Southwest Hospital – Code Red Dial
7777, Code Blue Dial 7777, All other codes Dial 0
 San Joaquin Hospital – Dial 700
 Delano Regional Medical Center – Dial 0
 Bakersfield Heart Hospital 5555
 Outside of the hospital facilities – Dial 911
Safety Management
 Safety Committee
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Holds regular safety meetings
Recommends or review safety polices and
procedures
Conduct safety inspections
Gets involved in corrective measures
Investigates accidents
Director of Safety / Security - Ken LaBrecque
 Safety Officers
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Each facility has a designated safety officer.
During your clinical rotation at the facility
determine who is the unit manager.
Any safety issues should be brought to the
attention of the instructor and the unit
manager
 Reporting Safety Hazards
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Contact floor Manager, Supervisor or
Coordinator at once..
 Policy and Procedures
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Policy & Procedures are found in each
department. Or are accessible via the
computer system.
At KMC, MH / MSH on-line Policies are
available to lookup
Found in each department are Red
Binders containing information of action
plans to address a variety of emergency
and safety situations.
Fire Safety Management
Fire Safety
RED
 Code
 Dial the emergency number for the facility
you are in
 R.A.C.E.
 P.A.S.S.
 Fire Extinguishers
 Drills
 Evacuation Plans
 Fire Alarms
Code RED Actions
Learn to RACE in an Emergency
Rescue
Get everyone away from immediate danger.
Alarm
Pull fire alarm station and call PBX with notification.
Confine
Close doors and windows to help keep fire and smoke from spreading.
Extinguish / Evacuate
Use fire extinguisher to extinguish fire and evacuate, if fire is out of control.
The Fire Extinguisher
 The Fire Extinguisher
 Pull
Pull the pin.
 Aim
Aim the nozzle at the base of the fire.
 Squeeze
Squeeze the operating handle to release the
extinguishing agent.
 Sweep
Sweep from side to side at the base of the fire until
the fire goes out.
General Evacuation Rules
Senior Management or Designee will
make the decision for a full evacuation.
Remember these rules:
Know the locations of the nearest fire doors.
Relocate patients horizontally first (other side of
nearest fire door).
Account for all patients and visitors.
Never leave a group of patients unattended.
Bring patient records with you.
Direct firefighters to the fire and to any patients
remaining in the unit.
Smoking Policy
 The health care facility’s endeavor to promote
health and wellness among patients, visitors
and staff.
 Adventist Health and Mercy Hospital/Mercy
Southwest Hospital are no smoking facilities.
This smoking policy has been developed to
restrict smoking to a minimum and only in
designated areas, in order to:
 Reduce risk to patients who smoke, including possible adverse
effects on treatment;
 Reduce risks of passive smoking for others; and
 To promote safety by reducing the risk of fire.
Code BLUE
Medical Emergency / Alert
 Dial the appropriate emergency number or use the
“panic button”.
 Determine unresponsiveness.
 Call a Code Blue.
 Begin your ABC Assessment.
 If needed begin CPR.
Utilities Management
 The Utility Systems Management Program
addresses processes that provide for
emergency procedures to be activated in the
event of utility system failure including:
 Specific procedures in the event of utility systems
malfunction;
 Identification of an alternative source of essential utilities;
 Shutoff malfunctioning systems and notification of staff in
affected areas;
 Obtaining repair services; and
 How and when to perform emergency clinical interventions
when utility systems fail.
Medical Equipment Management
 Reporting medical device events involves everyone.
Immediately report the event to your supervisor who
shall contact the appropriate person(s) or department.
 Any equipment that an employee feels is unsafe shall be
taken out of service immediately.
 Equipment has been place on a preventative
maintenance program. PM Tags are found on medical
equipment which identifies date and by when equipment
is due for maintenance.
Disaster Preparedness Management
 The Hospital Emergency
Incident Command System
(H.E.I.C.S.) can be found in your
departmental Red Disaster Binder.
 Each employee should know the
location of his or her hospital
H.E.I.C.S. storage center. Each
center is set-up to provide the
necessary supplies to implement
the system.
 Code Med Alert, Code Triage or
Code Disaster will be used to
alert staff to a disaster situation.
 All facilities conducts disaster drills
and every student will participate
when called upon.
Incident Command Locations
 Mercy Hospital - Clerou Lecture
Center
 Mercy Southwest Hospital – Café
Conference Room (aka Physicians
Lounge in Cafeteria)
 Bakersfield Memorial Hospital – First
floor North Tower – Radiology Area
 Kern Medical Center –
Administrative Conference
 San Joaquin Hospital –
Administration
 Bakersfield Heart Hospital -2nd Floor
classroom
Hazardous Waste & Materials Management
 Learn to recycle!
 Proper bags for proper use. RED, WHITE, BLUE YELLOW and
CLEAR.
 Bags at KMC – red-biohazardous waste, blue-line, yellow-chemo comes
from pharmacy in yellow bags, yellow bags are not used for disposal,
clear-trash, white- not used.
 Proposition 65 - Safe Drinking Water & Toxic Enforcement Act. The
State of California lists substances known to cause cancer or reproductive harm.
 Chemical Safety - Your Right to Know Chemicals in the Workplace.
 Asbestos notification requirements when asbestos is present.
 How Do I Report a Chemical Spill / Hazmat - Code YELLOW
(Mercy); ORANGE (BMH, ADVENTIST, KMC)
 MSDS on Demand Program.
 NFPA / MHMIS Labels (next slide).
MSDS On Demand
Hazardous Material Spill Actions
1. Call PBX Operator.
2. Clear Area Where Spill is Located.
3. Locate Material Safety Data Sheet /
MSDS on Demand.
4. KMC – Has stickers on telephones
1-800-451-8346 or 760-602-8703.
NFPA Label
The National Fire Protection Association (NFPA) 704 labeling system is
sometimes used for secondary containers.
Health Hazard
Fire Hazard
4 - Deadly
3 - Extreme Danger
2 - Hazardous
1 - Slightly hazardous
0 - Insignificant
4 - Below 73 F
3 - Below 100 F
2 - Below 200 F
1 - Above 200 F
0 - None
4
2
3
COR
Specific Hazard
Oxidizer
Acid
Alkali
Corrosive
Use no Water
Toxic High Temp
OXY
ACID
ALK
COR
W
TOX
Reactivity
4 - May detonate
3 - Shock and heat may detonate
2 - Violent chemical change
1 - Unstable if heated
0 - Stable
Security Management
 Public Safety
Provides protection to staff, patients and
visitors to facilities.
 Minimize Violence in the
Workplace
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Enforce Parking regulations.
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Oversees Workplace Violence Training.
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Offer employee and visitor escort
services.
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Handle Lost and Found Items.
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Investigates security and safety issues.
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Respond to Emergency Codes.
Learn and use security procedures.
Take advantage training offered.
 Violence in the Workplace.
Take threatening or violent behavior
seriously.
Take quick action and stay calm when
dealing with angry or violent people.
Have an action plan in place before a
violent incident occurs and practice it.
Learn what causes anger and the
warning signs of violent behavior.
Obtain and know policies and procedures
dealing with Violence in the Workplace.
Oxygen Safety Next
Oxygen Safety
Oxygen Safety Training
Standard Patient Care Orientation
Oxygen is essential for life.
Oxygen can also be dangerous during a
fire emergency. Your knowledge of the
interruption of piped-in oxygen and what to
do with flowing oxygen in the event of a
fire is crucial to saving lives.
Safe Oxygen Handling
and Storage
 Oxygen gas is contained in traditionally Green,
30 lb. steel tanks or cylinders.
 As oxygen is a hazardous chemical, each tank
must be labeled. All gases for medical use are
contained in color - coded tanks.
ALWAYS READ THE LABEL and confirm
that the tank you are going to use does contain
oxygen.
Carbon Dioxide – Helium - Nitrogen
Nitrous Oxide - Specialty Gas Mixtures
Safe Oxygen Handling
and Storage
 Oxygen tanks should be stored in a rack or carrier in an upright
position. If no rack or carrier is available, the oxygen tanks may
be secured to the wall in an upright position by a chain or strap.
 Oxygen tanks should never be stored lying down.
 If a tank is stored with the regulator and/or flow meter attached,
make sure both the regulator and flow meter are turned OFF.
OXYGEN TANK MUST BE STORED WITH
THE VALVE CLOSED.
 Tanks should be stored in such a way to prevent
falls. A falling 30 lb. tank can cause injury. If the valve of an
oxygen tank breaks due to a fall, the oxygen tank can become a
30 lb. missile which can cause grave danger to people, and loss
of and/or expensive repairs to equipment and the structure.
Safe Oxygen Handling
and Storage
 Oxygen tanks are heavy and should be handled
in a carrier for safety.
 Oxygen tanks that are empty or “not in use” may
be stored in an oxygen storage room. Check
with your supervisor for the location of the floors
or department’s oxygen storage rooms.
 Storage of compressed gas cylinders are
governed by codes of the National Fire
Protection Association (NPFA), along with local
codes.
Oxygen and Fire Danger
 Intentional oxygen shut - off should only occur in the event of a fire
emergency or leak in the system. While oxygen itself is not flammable
or explosive, it will feed a fire and cause it to burn hotter and faster. If
you discover a fire in a patient room, rescue the patient from the room,
activate the R.A.C.E. protocol, and follow institution specific
instructions.
 ABSOLUTELY NO SMOKING IS PERMITTED IN
ANY ROOM WHERE OXYGEN IS IN USE OR ON
STANDBY!!! AN “OXYGEN IN USE” SIGN
SHOULD BE POSTED WHEN O2 IS IN USE.
 Only designated personnel should shut off the floor or zone oxygen
after assessing the consequences. Patients requiring oxygen will need
to be connected to portable oxygen.
 Know the locations of how to obtain and the use of portable oxygen
tanks, regulators, flow meters, “Christmas tree” or multi prong adapters,
as well as the tank key.
ALWAYS STORE
AND HANDLE
OXYGEN
IN A SAFE
AND
RESPONSIBLE MANNER.
Hospital
Infection Control
Education
INFECTION CONTROL
IT’S
EVERYONE’S
BUSINESS
24 / 7.
Purpose Statement
Learn to Identify:
 How infections are spread.
 How to protect patients and
visitors from cross - infection.
 How to protect yourself.
Standard Precautions &
Expanded Precautions
 Consider all patients
potentially infectious.
 Use appropriate
barrier precautions at all
times.
Hand Washing
 The most important
measure you can
use to prevent the
spread of infection.
Hand Washing
 Most hospital acquired infections
are transmitted on
the hands of
healthcare
workers who don’t
wash hands, or
inadequately wash
their hands.
Healthcare – Associated
Infections is the U.S.
 Most common
complication of
hospitalized patient.
 2 million patients per
year.
 90,000 deaths result.
 Cost $4 to 6 billion.
Self - Reported Factors for Poor
Adherence with Hand Hygiene
 Handwashing agents cause irritation and dryness.
 Sinks are inconveniently located / lack of sinks.
 Lack of soap and paper towels.
 Too busy / insufficient time.
 Understaffing / overcrowding.
 Patient needs take priority.
 Low risk of acquiring infection from patients.
Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.
Another Reason Why Personnel
Don’t Wash Their Hands Often
 Frequent handwashing
with soap and water
often causes skin
irritation and dryness.
 In the winter months,
some personnel may
even develop cracks in
their skin that cause
bleeding, as seen in the
adjacent figure.
Many Personnel Don’t Realize
When They Have Germs on Their
Hands
 Nurses, doctors and other healthcare
workers can get 100’s or 1000’s of
bacteria on their hands by doing simple
tasks, like:
• pulling patients up in bed;
• taking a blood pressure or pulse;
• touching a patient’s hand;
• rolling patients over in bed;
• touching the patient’s gown or bed sheets;
• touching equipment like bedside rails, IV
pumps.
 Culture plate showing
growth of bacteria 24
hours after a nurse
placed her hand on the
plate.
Specific Indications for
Hand Hygiene
 Before:
• Patient contact.
• Donning gloves when inserting a CVC.
• Inserting urinary catheters, peripheral vascular
catheters or other invasive devices that don’t
require surgery.
 After:
• Contact with a patient’s skin.
• Contact with body fluids or excretions, non – intact
skin or wound dressings.
• Removing gloves.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
Are Alcohol – Based Handrubs
Really Effective?
 More than 20 published studies
have shown that alcohol - based
handrubs are more effective than
either plain soap or antibacterial
soaps in reducing the number of
live bacteria on the hands.
•But wash hands if soiled with blood,
secretions or dirt.
Efficacy of Hand Hygiene
Preparations in Killing Bacteria
Good
Plain Soap
Better
Antimicrobial
soap
Best
Alcohol-based
handrub
SUMMARY:
Alcohol – Based Handrubs
(What benefits do they provide?)
 Require less time.
 More effective for standard handwashing than
soap.
 More accessible than sinks.
 Reduce bacterial counts on hands.
 Improve skin condition.
Recommended
Hand Hygiene Technique
 Handrubs
• Apply to palm of one hand, rub hands together
covering all surfaces until dry.
• Volume: based on manufacturer.
 Handwashing
• Wet hands with water, apply soap, rub hands
together for at least 15 seconds.
• Rinse and dry with disposable towel.
• Use towel to turn off faucet.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
Fingernails & Artificial Nails
 Natural nail tips should be kept to ¼ inch in
length.
 Artificial nails are not permitted for health care
workers with responsibilities for direct patient
contact, preparation of food or medical
supplies.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;
vol. 51, no. RR-16.
Wear Gloves
 When touching blood, body fluids, mucous
membranes or non-intact skin of all patients.
 When handling items or touching surfaces
contaminated with blood or body fluids.
 Wash hands after removing gloves.
 Change gloves between patients.
Wear Masks &
Protective Eye Wear
 During procedures that are
likely to cause splashes of blood
or other body fluids (to protect the
mucous membranes of the eyes,
nose, and mouth).
Wear Gowns
During procedures
that are likely to
generate splashes of
blood or other body
fluids.
Standard Precautions & Expanded
Precautions
 Additional isolation measures
are necessary to prevent
transmission of:
• Antibiotic - resistant bacteria.
• Highly - contagious
microorganisms.
Standard Precautions & Expanded
Precautions
Strict Contact
Precautions
 Strict Contact Isolation • MRSA, Vancomycin Resistant
Enterococci (VRE), C. Difficile
Droplet
Precautions
 Droplet Precautions -
Airborne
Precautions
 Airborne Precautions -
• Pertussis, Meningococcal
Pneumonia / Meningitis
• TB, Measles, Chickenpox
Standard Precautions & Expanded
Precautions
Strict Contact  Strict Contact Isolation • MRSA, VRE, C. Difficile
Precautions
 Requires that all persons entering
the Strict Contact Isolation Room
must wear a gown and gloves.
 All equipment must be disinfected
prior to being removed from the
isolation room.
Colonized or Infected
(What is the Difference?)
 People who carry bacteria without evidence of infection
(fever, increased white blood cell count) are colonized.
 If an infection develops, it is usually from bacteria that
colonize patients.
 Bacteria that colonize patients can be transmitted from
one patient to another by the hands of healthcare
workers.
~ Bacteria can be transmitted even if the patient
is not infected. ~
The Iceberg Effect
Infected
Colonized
Recovery of VRE from Hands &
Environmental Surfaces
 Up to 41% of healthcare worker’s hands
sampled (after patient care and before
hand hygiene) were positive for VRE1.
 VRE were recovered from a number of
environmental surfaces in patient rooms.
 VRE survived on a countertop for up to 7
days2.
1
Hayden MK, Clin Infect Diseases 2000;31:1058-1065.
2 Noskin
G, Infect Control and Hosp Epidemi 1995;16:577-581.
The Inanimate Environment Can
Facilitate Transmission
X Represents VRE Culture Positive
Sites
~ Contaminated Surfaces Increase Cross Transmission ~
Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient
Environment. Hayden M, ICAAC, 2001, Chicago, IL.
Bad Bugs are Survivors
Hospital pathogens survive on surfaces for
extended periods of time:
 Hepatitis B
 Acinetobacter baumannii
 Clostridium difficile
 VRE
 MRSA
at least 1 week
33 days
70 days
4 months
9 months
Clean is the Best Defense
Daily clean high - touch surfaces with a
disinfectant:
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Bed rails
Overbed tables
Light switches
IV pump controls
Phones
Computer keys
Bloodborne Pathogens
Healthcare workers have an
occupational risk of exposure to
Bloodborne Pathogens:
HIV, Hepatitis B, Hepatitis C
Bloodborne Pathogens
Bloodborne viruses may infect a
person by being introduced via:
 Openings in the skin (cuts,nicks).
 Punctures or cuts from contaminated
sharps.
 Mucous membranes - eyes, nose and
mouth.
Human Immunodeficiency Virus
(HIV)
 Attacks immune system,
eventually resulting in AIDS.
 Initially when infected with HIV a
person has flu-like symptoms
(fever, diarrhea, fatigue).
HIV
The virus may be present in these
body fluids:
 Blood, semen, vaginal secretions, CSF,
synovial, pleural, peritoneal, pericardial and
amniotic fluid
 Unfixed tissue or organs
 Any body fluid containing blood
HIV
Risk of HIV infection:
 Needlestick 0.3%
 Non-intact skin or mucous membrane
exposure
<0.1%
Centers for Disease Control (2010). Retrieved from
http://www.cdc.gov/hepatitis/statistics.htm
Hepatitis B
Transmitted in blood, saliva
and semen:
In 2007, an estimated 43,000
persons in the U.S. were
infected with Hepatitis B.
 3000 die per year.
Centers for Disease Control (2010). Retrieved from
http://www.cdc.gov/hepatitis/statistics.htm
Hepatitis B
 Risk of infection from a
needle stick or mucous
membrane contact ranges
from 3 - 30%
Hepatitis C
Spread by contact with infected
blood.
Risk of infection from a
needlestick or mucous
membrane contact ranges
from 1 - 10%.
Centers for Disease Control (2010). Retrieved from
http://www.cdc.gov/hepatitis/statistics.htm
Safe Handling of
Needles & Sharps
 Use appropriate sharps
containers.
 Discard used sharps
immediately.
 Avoid recapping
needles.
Blood / Body Fluid Exposures
 Apply First Aid.
 Report exposures immediately.
KMC – contact clinical instructor as well as charge
nurse. Charge nurse will facilitate contact with Employee
Health. If after hours, the charge nurse will contact the
nursing supervisor. Students should not fill out an
occurrence report. As part of the exposure packet, the
charge/supervisor will complete the occurrence report.
 Fill out incident report.
 Contact Employee Health.
When Employee Health is closed contact Clinical Coordinator.
Things You Should Know!
 Cleaning Blood Spills
 Hepatitis B Vaccine
 Exposure Control Plan
Tuberculosis (TB)
 Why It’s Back.
 How We Can
Protect Ourselves.
TB Transmission
Lungs are most common site of
infection.
Transmitted by inhaling airborne TB
droplet when infected person coughs
or sneezes.
Signs & Symptoms of TB
Productive cough.
Hemoptysis (blood in sputum).
Night sweats.
Fatigue.
Unexplained weight loss, (15 - 20
lbs.).
TB Control Measures
Airborne
Precaution
s
 TB risk-assessment of all
patients.
 Airborne Isolation.
 Negative Pressure Room.
 TB respirator (N95 mask).
 TB skin tests (INH for
converters).
Medical Waste Disposal
 Place medical waste
in red biohazard bags
for disposal.
 Items which have
liquid blood
contamination must be
placed in red bags.
Individual Employee Health
 Practice good personal hygiene.
 Keep current on immunizations.
 At least annual PPD screening.
 Report exposures to communicable
diseases.
 Work restrictions for some infections.
 Other.
Social Services
Social Services
Scope of Services
Definition: Responsible for assisting
patient’s families in adapting to life
changes brought about by the patient’s
illness or psychosocial factors that place
the patient / family at risk.
Social Services
Scope of Services
 Crisis Intervention
 Issues with Problem Identification and/or
Resolution
 Supportive Counseling
 Community Resources and Information / Referral
 Grief Support
 Staff Needing Consultation and/or Support
Social Services
Other Roles
Community Resources Planning
Inter. and Intra Hospital Committee
Participation
Community Wide Liaison
Social Services
Mandated Services Areas
 Labor and Delivery / Birthing Center
 NICU
 Any hospitalized Children
 Cancer Patients / treatment areas
 Emergency Department
 Skilled Nursing Facilities
 ICU
Social Services
Should be Notified of Any of the Following:
Children



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Any trauma to children 5 years and
under
Any alleged abuse to children
physical, sexual, emotional,
neglect
Any children being transferred to a
hospital out of the area
Teen pregnancy
Death
Mental Health
issues related to admission or
current well-being
Suicide
attempt, overdose
verbalizing any suicidal /
homicidal thoughts
Drug / Alcohol abuse
Fetal Demise
Birth Anomalies
Adults

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
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John / Jane Doe
Any alleged abuse to adults
physical, sexual, emotional,
neglect
Homeless related to problem discharge
Death
Mental Health
issues related to admission or
current well-being
Suicide
attempt, overdose
verbalizing any suicidal /
homicidal thoughts
Drug / Alcohol abuse
Elder patients living alone
Indicators
-Behavior
Child
Care Giver
-Aggressive
-Gives
-Withdrawn
-Unusual knowledge of
sex
-Tardiness or absence
from school
-Unusual fears (of
people or going home)
-Crying for attention
-Lack of concentration
-Ducking or flinching in
response t touching
-Leaving parents
without hesitation
-Lack of reaction to
painful procedure
-Feeling of guilt for
injury
-Unusual relation
mechanism to parent
-Inconsolable crying in
infant, history of
conflicting
reports
regarding
injuries
-Becomes
defensive when
asked about
injuries
-Refers to child
as difficulty,
different
-Does not
demonstrate
support,
comfort,
empathy
-Blames
child/adult
circumstances
for injuries
-Does not allow
child to answer
questions
-Reactions in
hostile or
aggressive way
-Overprotective
of significant
other
Adult/
Spouse
-Fear
-Withdrawal
-Depression
-Helplessness
-Resignation
-Anger
-Confusion
disorientation
-Denial
-Nonresponsivenes
s
-Agitation or
anxiety
hesitation to
talk openly
-Poor eye
contact
-Conflicting
accounts of
incidents by
the family
Elderly
-Increasing depression
-Anxiety
-Withdrawn
-Timid
-Hospital
-Unresponsive
-Confused
-Longing for death
-Anxious to please
-Shopping for physicians
Indicators
-Signs of Physical
Neglect/ Abuse
Child
-Missing hair
-Burns
-injuries, redness
around genitalia
Bruises, welts, or
broken bones
_injury or medical
condition that has
not been properly
treated
-Unexplainable old
injuries
-Injuries at different
stages of healing
-Injuries that do not
match history
-Poor hygiene
Care Giver
-New health
problems
-New affluence
-Withholding food
or medicine
-Substance abuse
-Unusual fatigue
-New self-neglect
-Suicide attempts
Adult/ Spouse
-Frequent visits to
ER
-Multiple injuries at
various stages of
healing
-Evidence of
alcohol or drug
abuse
-Injuries
inconsistent with
patient’s report
-Eating disorders
-Lacerations,
burns, vague or
non-specific
physical or
psychological
complaints of
fatigue, anxiety,
depression, nerves,
fearfulness, loss of
appetite,
dissociation,
chronic headaches,
insomnia, atypical
chest pain
Elderly
-Signs of injury
(profile similar to
child or adult)
-Vague health
complaints
-Pallor
-Wasting
-Dehydration
-Decubiti
-Poor personal
hygiene
-History of eating
accident prone
-Home alone
-Over/under
medicated
Agency Contacts

Victims of Domestic Violence:




Resident of a Residential Care Home or Nursing Home:


Long Term Care Ombudsman 325-5943, ext.109 or 323-7884
Agencies to Contact About Abuse:


Alliance Against Family Violence 24 Hour Hotline 661-327-1091
Bakersfield Police Department 327-7111
Kern County Sheriff’s Department 861-3110
Child Protective Services 631-6011
Age 65 or Older or Dependent Adult Between 18-64:

Adult Protective Services 868-1006
CONFIDENTIALITY and
PROTECTED HEALTH
INFORMATION
Individually Identifiable Health Information
(PHI)


Defined as:
 Any one of 18 defined demographics
 the past, present and future physical or
mental health conditions, treatments
and payments.
Applies to data that is electronically stored
and transmitted, even if stored in a nonelectronic form at a later time












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



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Name
Address
Names of relatives
Names of employees
Birth date
Telephone number
Fax numbers
E-mail addresses
Social Security Number
Medical record number
Health plan beneficiary number
Account number
Certificate / license number
Any vehicle or other device serial number
Web URL
IP address
Finger or voice prints
Photographic images and any other number,
characteristic or code that may be used to
uniquely identify an individual
PHI (continued)
Policies specifically impacting the patient
and facility are located in the policies of
each facility under the HIPAA section.
Direct questions to the Instructor and Unit
manager of the facility
Policies are developed through
collaboration of the facility compliance
officer / team and administration or
corporate leadership
Patient Confidentiality
 It is everyone's responsibility to protect patient information and
confidentiality.
 Patient have the right to restrict the release of their information to others
that are not part of treatment, payment, or operations.
 Do not contact anyone in the community about a patient admission unless it
is part of your job function.
 Do not share or discuss patient information with those that don’t need to
know, i.e. with hospital staff or anyone in the community.
 Do not discuss patient information in public areas.
 If the law requires that you report patient information you don’t need the
patient authorization to do so i.e. reporting abuse.
 Access to protected health information is restricted by job function and need
to know. This is based on the minimum needs of the position.
 Staff and physicians involved in the patient’s TPO are permitted to discuss a
patients conditions or other types of protected health information.
Facility Patient Directory
 Refers to the location of the patient within the facility
 Patients may restrict or prohibit the use of their information in
the facility directory i.e. OPT OUT.
•
•
•
The FPD process is completed at the time of admission and is recorded in the
hospital system.
If a patient opts-out of the FPD an “Opt-out” comment or symbol is entered by
the patients name and will show with any report having a patient name listing.
If you don’t have access to a patient report that lists their name, you must refer
the question to the PBX Operator.
Patient information will be provided only when
the request is for information by patient first
and last name.
Patient’s Family, Friends Access to PHI
 You may disclose PHI to members of the patient’s family, friends, or
any person identified by the patient as being involved in their care or
payment, if patient has agreed to the disclosure.
 Disclose only PHI that is directly relevant to the family and friends’
involvement with patient’s care or related payment.
 This authorization process is completed at the time of
admission and includes a form which indicates who is
permitted and what the patient’s code is. The authorization
form is include in the patient’s medical record.
 Use professional judgment about disclosures in an emergency or
when patient is unable to express agreement.
 You may disclose a patient’s location, general condition, or death to
notify, identify, or locate a family member or personal representative of
the patient.
Accounting of Disclosures
 Patients have a right to receive an accounting of certain
disclosures of their PHI that go beyond the facility’s use
and disclosure for Treatment, Payment, and Healthcare
Operations (“TPO”).
 Includes most disclosures for public health or law enforcement
purposes, including verbal disclosures.
 Examples include birth records, registries, infectious disease, and
disclosures under court order or subpoena.
 Excludes disclosures authorized in writing by the patient,
disclosures through the facility directory, and those for TPO.
 If your job requires that you disclose PHI to third parties,
it is your responsibility to know the specific policies
regarding such disclosures and the exact requirements
to document and record them.
Documentation of the disclosure must include the
following elements:
 Date of disclosure.
 Name of the entity or person who received the PHI and if known the
address.
 A listing of the type of PHI released i.e. name, address, date of birth,
social security number, phone number, admission/discharge date;
medical information; treatment information billing information.
 Manner of the disclosure i.e. In person; mailed; telephone; fax;
email.
 Purpose for PHI disclosure.
 If multiple disclosure to the same entity or person, the frequency,
periodicity, or number of disclosure during the accounting period and
the date of the last disclosure.
 Tracking forms are available for this purpose, check with your
department supervisor for the process used in your department.
Investigation & Mitigation of a Breach of
Privacy / Confidentiality
 If you know of a breach of patient privacy or
confidentiality, you must immediately report it to
your Facility Privacy Official (FPO).
 The FPO will investigate and respond to all
privacy and security complaints.
 Any breach by a staff or others is subject to
formal corrective action as set forth in policy.
Sanctions Policy
 The following process must be followed when an employee breaches,
or is suspected of breaching confidentiality or Patient Privacy.
 Level 1
 Observer reports it to his/her immediate supervisor, FPO, or Human
Resources Director.
 The supervisor or FPO, as applicable, shall report the incident to the
Human Resources Director.
 Anonymous reports of a Breach of Patient Privacy or Confidentiality
are acceptable.
 The supervisor and HR Director will identify and implement an
appropriate action plan and communicate the plan to the FPO.
 Levels 2 and 3
 The HR Director shall establish an investigative team that will
include the HR Director, the senior manager of the employee’s
department and the FPO.
(continued)
Sanctions Policy continued…
 Levels 2 and 3, continued
• The investigative team will interview all involved parties and
write a report.
• The HR Director and departmental manager will decide upon
the corrective action.
 Reporting and filing requirements
 For all levels of breach, the initial report and all written
documentation relating to it will be maintained in a confidential file in
Human Resources for a minimum period of six (6) years.
 All disciplinary action will be filed in the employee’s personnel file.
 A summary of the incident and the results of any mitigation will be
maintained by the FPO.
 Employees may appeal discipline under this policy pursuant to the
existing mechanisms available at each the facility, e.g., dispute
resolution, collective bargaining, By Laws, etc.
Protecting Passwords
Memorize your password and do not write it
down or post it where it is accessible to others.
If you do write them down, keep that piece of
paper secure.
Do disguise them as something else, like
entries in an address book.
Do not share your passwords, not even with
your supervisor or IT personnel.
If you suspect your password has been
compromised, call the help desk to report and
change your password.
Picking Good Passwords
 Do base them on a favorite phrase or image, so they'll be easier to
remember (avoid names, birthdays, pet’s names, etc.).
 Do make them long (at least seven characters, ideally longer).
 Do include mixes of uppercase letters, lowercase letters, numbers,
and symbols like _*&^%$#@!.
 Do use at least four different characters (don't just repeat the same
ones).
 Do use different passwords for different systems, and change them
once in a while.
 Don’t use a real word in any language unless you alter the spelling
substantially.
 Don't use consecutive letters, numbers or adjacent keyboard
characters (“abcdefg”... “1234567”... “qwertyu”).
Controlling Documents and Files
Do not email or FTP PHI or sensitive
information outside of the hospital network
without approved methods of secure file
transfer. Contact IS Helpdesk.
Do not copy PHI or sensitive information to
any removable media, such as diskettes or
CDs unless you can store the media
securely.
Malicious Software
 SPAMS, SPOOFS, HOAXES AND PHISHES
Unsolicited email isn’t just annoying; it can be
dangerous.
 Watch out for “phishing”. Email that asks for
sensitive information about you or your
organization – or that points you to a web site
that asks for information.
 Be cautious about any email that asks you to do
something – such as open an attachment or
click on a link to visit an unfamiliar web site.
Malicious Software (cont)
The attached file could contain a virus or
other malicious software, including dataharvesting spyware.
That web link could take you to a phishing
site that looks genuine, but is actually
aiming to get information from you in order
to commit identity fraud.
Monitoring
Web access and email content are
monitored.
E-mail and web access are business tools
intended for business purposes.
Refer to the hospital Network Usage
Policy for additional information on
approved and prohibited uses of network
resources.
A Way of Conducting Business &
Delivering Services
“What Can I Do?”
Every Healthcare worker has the Right &
Responsibility to:
Contact Instructors and Hospital Resources
with Questions and / or Concerns
Contact the Compliance officer or Compliance
Hot Line to the facility
 CHW Compliance Hotline 1-800-938-0031
 KMC Compliance Hotline 326-2665. The county’s number
is 1-800-620-6947.
Patient Safety
Prevention of Harm
What is Patient Safety?
Providing safe patient care.
Providing a safe environment
for patients, families, visitors
and staff.
Reporting errors.
Why is Patient Safety Important?
Patients expect to receive
excellent and safe care.
It’s why we are in business. It’s
the RIGHT thing to do.
Regulatory agencies require
excellent, safe care to be
provided.
National Patient Safety Goals
(2010)
Guide Joint Commission accredited organizations
address specific areas of concern in regards to patient
safety
National Patient Safety Goals (2010) continued
 Improve the accuracy of patient identification.
Use at least two patient identifiers when
providing care, treatment or services.
KMC uses the patient’s name and date of
birth, policy PCM-IM-100
Eliminate transfusion errors related to patient
misidentification.
National Patient Safety Goals (2010) continued
 Improve the effectiveness of communication among caregivers.
 For verbal or telephone orders or for telephonic reporting of
critical test results, verify the complete order or test result by
having the person receiving the information record and "readback" the complete order or test result.
 Policy PCS-PC-920 outlines this process at KMC
 Standardize a list of abbreviations, acronyms, symbols, and
dose designations that are not to be used throughout the
organization.
 Measure and assess, and if appropriate, take action to improve
the timeliness of reporting, and the timeliness of receipt by the
responsible licensed caregiver, of critical test results and values.
 Implement a standardized approach to “hand off”
communications, including an opportunity to ask and respond to
questions.

National Patient Safety Goals (2010) continued
 Improve the safety of using medications.
Identify and, at a minimum, annually review a list of
look-alike/sound-alike drugs used by the organization,
and take action to prevent errors involving the
interchange of these drugs.
Label all medications, medication containers (for
example, syringes, medicine cups, basins), or other
solutions on and off the sterile field.
Reduce the likelihood of patient harm associated with
the use of anticoagulation therapy.

National Patient Safety Goals (2010) continued
 Reduce the risk of health care-associated infections.
 Comply with current World Health Organization (WHO) Hand
Hygiene Guidelines or Centers for Disease Control and
Prevention (CDC) hand hygiene guidelines.
 Manage as sentinel events all identified cases of unanticipated
death or major permanent loss of function associated with a
health care-associated infection.
 Implement evidence based practice (EBP) to prevent health care
associated infections due to multiple drug-resistant organisms in
acute care hospitals.
 Implement best practices or EBP to prevent central lineassociated bloodstream infections.
 Implement best practices for preventing surgical site infections.
National Patient Safety Goals (2010) continued
 Accurately and completely reconcile medications
across the continuum of care.
 There is a process for comparing the patient’s current
medications with those ordered for the patient while under the
care of the organization.
 Policy PCS-MM-900 outlines the process at KMC
 A complete list of the patient’s medications is communicated to
the next provider of service when a patient is referred or
transferred to another setting, service, practitioner or level of
care within or outside the organization. The complete list of
medications is also provided to the patient on discharge from the
facility.
 In settings where medications are used minimally, or prescribed
for a short duration, modified medication reconciliation
processes are performed.
National Patient Safety Goals (2010) continued
 Reduce the risk of patient harm resulting from falls.
 Implement a fall reduction program including an evaluation of the
effectiveness of the program.
 Encourage patients’ active involvement in their own care as a
patient safety strategy.
 Define and communicate the means for patients and their families to report
concerns about safety and encourage them to do so.
 The organization identifies safety risks inherent in its patient
population.
 The organization identifies patients at risk for suicide.
 Policy NRS-PC-1150 outlines the assessment of high risk patients at KMC
 Improve recognition and response to changes in a patient’s
condition.
 The organization selects a suitable method that enables health care staff
members to directly request additional assistance from a specially trained
individual(s) when the patient’s condition appears to be worsening. [Critical
Access Hospital, Hospital].
KMC - The Universal Protocol
 Pre-procedure verification
 Mark the site
 Perform a time-out
 KMC’S process is outlined in policy PCS-PC-815
 Shalom Sakowski BSN, RN-Coordinator
Office located in room 3319
326-5451
[email protected]
 Frances Wilson MSN, RNC, OCN-Clinical Nurse Specialist
Office located on 3D
326-2267
[email protected]
What Do I Do, if I Make a
Mistake?
1. Notify your instructor or charge nurse immediately
of any error or unsafe conditions.
2. Complete an Event Report Form - you can remain
anonymous.
1.
KMC – The unit charge nurse or supervisor will complete
and occurrence form.
3. Assist in any investigation and follow up to help
determine why the mistake happened and how to
prevent this from happening again.
Patient Safety
You Make it
Happen!!!
Developing Cultural Diversity
“It Starts With Self - Awareness.”
Considering Every Patient’s
Culture When Giving Care.
 Culture – the values, beliefs and practices share by a
group -- can affect how a patient views health care. A
patient may belong to different ethnic, regional,
religious and other groups.
 Treating every patient as an individual – it’s
important to consider culture. But it’s also
important to:
 Avoid stereotyping;
 Consider other factors that may affect care, such as age;
and
 Learn about each patient’s unique views on health care.
Why Learn About
Cultural Diversity?
Because developing an understanding of
cultural diversity benefits everyone. You can:
 Help patients receive more effective care – taking patients’
cultural views on health into account helps maintain their
right to be treated with respect. They also respond better to
their care.
 Helps our facility meet or exceed the standards of regulatory
agencies.
 Improve your job performance – helping patient get the
best possible care can also increase your job satisfaction.
Know Your Own Cultural
Beliefs and Practices.
Think about how your culture and upbringing
affect you. For example, you may have
certain ideas about:
 How to show politeness when talking with
someone.
 Acceptable ways to express pain.
 How often to seek medical care.
 Appropriate ways to treat children or older people.
There are Many Cultural Factors
to be Aware of.
 Country of Origin
 Preferred Language
 Communication Style
 Views on Health
 Family and Community Relationships
 Religion
 Food Preference
Take Time to Learn About
Your Patients.
 Ask questions to avoid cultural stereotypes. It’s
important to have general knowledge about a culture.
But it’s also important to assess each individual patient
because;
Difference exist among member of the same cultural
group.
Cultures change over time.
Climate, war, etc., in another country may have affected
an immigrant’s health.
Take the Time to Consider
and Learn.
How a patient prefers to be addressed.
Understand relationships.
Consider privacy needs.
Learn the patient’s views about health.
“Work with the patient and others to find the
best approach of his or her care.”
Communicate Effectively.






Listen to how the patient talks about his or her condition.
Ask for any details you may need to understand better.
Ask what he or she thinks.
Ask indirect questions, if needed.
Look for clues.
Talk with others who know the
patient.
 Ask for the patient’s views on
treatment.
 Use interpreters effectively.
Consider Other Factors
That May Affect Care.
 Age –
An older patient may assume certain problems are a normal part of
aging and not mention them.
 Gender –
A patient may prefer to receive care from some of the same sex.
 Sexual Orientation –
Asking questions that avoid assuming sexual
orientation can help put him or her at ease.
 Socio-Economic Status –
Financial hardship may keep a patient
from seeking or following treatment.
 Presence of a Physical or Mental Disability –
disabling a certain condition is.
How
Interpreter Services
INTERPRETER Services
 To enable Physicians and Hospital staff members to
communicate with our hospital patients. For those
patients who do not speak sufficient English, or who
are hearing impaired; or upon the patient’s request,
or when a staff member or physician determines that
the patient’s lack of fluency in English affects the
ability to understand or make decisions regarding
treatment. Interpreter services will be provided by
telephonic means and/or by qualified Sign-Language
interpreter.
PATIENT IDENTIFICATION
 Patients requiring interpreters will be identified at the
time of registration or by staff on the unit.
CHW uses services provided by Cyra Com
International and Life Signs INC for hearing
impaired.
KMC uses an internal translator list as well as a
Translation – Language line and -Life Signs INC for
hearing impaired.
San Joaquin Hospital uses Telelanguage 1-800514-9237 (Code # on phone)
 Interpreters (i.e. family members or friends) will be used
only after the patient has been clearly been informed of the
unavailability of available interpreter services.
An Issue of Respect
Upon completion of this program, you will:
 Understand the wide range of behaviors that may constitute
discrimination and harassment;
 Understand who can be a victim;
 Understand that free speech rights don’t apply in the work place;
 Understand what constitutes a “tangible employment action”;
 Understand that everyone has a right to work in an environment
free from discrimination and harassment; and
 Determine how to appropriately respond during a harassment
situation.
An Issue of Respect
Harassment means to trouble, worry or
torment someone on a persistent basis.
The important phrase here is “on a
persistent basis.” Usually a one - time
offense is not considered harassment in
the eyes of the law.
An Issue of Respect
Types of Harassment:
 Verbal – includes things said, written or
inappropriate sounds.
 Physical – includes hitting, pushing, blocking
someone’s way, inappropriate touching.
 Visual – includes calendars, pictures, and any
inappropriate object that can be clearly seen.
An Issue of Respect
There are two main types of sexual harassment:
 Quid Pro Quo — occurs when employment decisions such as
hiring, promotions, salary increases, work assignments or
performance evaluations are based on an employee’s willingness to
grant or deny sexual favors.
 Hostile Work Environment — occurs when verbal, physical, or
visual behavior in the workplace:
o Focuses on the sexuality of another person or occurs because of
the person’s gender;
o Is unwanted or unwelcome; and
o Is severe or pervasive enough to affect the person’s work
environment.
An Issue of Respect
Discrimination occurs when a person or
group of people are treated differently
from another person or group of people.
An Issue of Respect
Discriminatory harassment is harassing
and/or discriminating behavior that is
severe or pervasive enough to create a
hostile working environment and/or
results in a tangible employment action.
An Issue of Respect
Title VII of the Civil Rights Act of 1964 prohibits
discrimination on the basis of race, sex, religion,
national origin, color, pregnancy, etc.:










Race
Religion
Sex
National Origin
Age
Disability (Including
obesity)
Military Membership or
Veteran Status
Sexual Orientation
Marital Status
Transsexual or CrossDressing








Political Affiliation
Criminal Record
Prior Psychiatric Treatment
Occupation
Citizenship Status
Personal Appearance
Education
Tobacco Use Outside of
Work
 Receipt of Public Assistance
 Dishonorable Discharge
from the Military
An Issue of Respect
Now that we have completed this program, you should:
 Understand the wide range of behaviors that may constitute
discrimination and harassment;
 Understand who can be the victim;
 Understand that free speech rights don’t apply in the workplace;
 Understand what constitutes a “tangible employment action”;
and
 Understand that everyone has a right to work in environment
free from discrimination and harassment.
Customer Service &
Patient Satisfaction
Customer Service and
Patient Satisfaction
are an important part
of your job. Make it a
priority.
What Exactly is
Customer Service?
Technical Aspects of Care Provided:
 How diagnostic procedures are performed.
 Examples: a broken bone healed properly, the patient
recovered from illness, blood flow was restored, etc.
Customer Service:
 How long they had to wait.
 How noisy it was.
 How comfortable they were.
 Whether or not they were treated with courtesy and
respect.
Patient Satisfaction Depends on
Customer Service…
 Patients want and expect to receive good
customer service, as well as high-quality
healthcare care. In today’s competitive
health-care marketplace, the two go hand-inhand to determine patient satisfaction and
how well you meet your customers’ needs
and expectations.
Some Tips for Effective
Telephone Use…
When Answering Calls:
 Answer promptly and politely.
 Take careful notes and messages.
 Put people on hold or transfer calls only if
you can’t avoid it.
 Be pleasant and professional.
 Always end on a positive note.
Put Contacts with Patients
to Work…
 Remember, every patient contact is an
opportunity to provide good customer
service and to find out how we are doing.
 Ask at every opportunity.
 Take complaints seriously.
 Report problems promptly.
If You Mess Up - Confess Up.
GUIDELINES FOR PROFESSIONAL
APPEARANCE
CSUB nursing students represent the University and the
Department of Nursing when interacting with patients,
their families, staff, and others in the health care
environment. The way students dress demonstrates
respect for the University they represent and for the
patients and families they serve. Students purchase
and wear the uniform of the Department throughout
their clinical experience, unless the clinical instructor
advises otherwise. While wearing the CSUB uniform,
students are clearly recognized at the University and
by the clinical agencies accommodating student
experience. Professional attitudes and clothing
reflect the same respectful behavior and professional
attitudes even when the CSUB uniform is not
required in the clinical area.
Personal Appearance
 Hair: Hair is neatly maintained, clean and kept off the
collar. Hair is pulled back to prevent it from falling
forward over the face while performing routine nursing
duties. Any extreme look or color is not permitted. Plain
barrettes or combs are allowed. Men may choose a
neatly trimmed mustache or beard. Facial hair is
maintained in short style to insure adequate seal for
respiratory isolation masks/particulate respirators. No
handle bar style mustaches or long beards are
acceptable.
 Makeup: Makeup is fresh and natural. Extremes in
color, glitter, or amount are not acceptable.
 Nails: No acrylic nails, extenders, polish or long nails
are permitted Hands and nails are clean and free of any
stains.
 Perfume: Close contact with patients and staff requires
students not wear fragrance/perfume or after shave.
Personal Appearance (continued)
 Sunglasses: Sunglasses may be perceived as
blocking interpersonal communication. Do not
wear them indoors, however, polarized glasses
that tint light gray in bright light are acceptable.
 Hygiene: Personal hygiene must be of high
standards. Absence of body, mouth and clothes
odor is necessary. Do not chew gum or
smokeless tobacco while in clinical areas.
Students may smoke only in the designated
areas during assigned meal or break time.
Personal Appearance (cont)
 Jewelry: The following jewelry is allowed: a) One small
post earring (with no dangles) in each ear; b) One small
ring; c) Small necklaces and neck chains inside the
uniform; d) ankle chains that are not visible or audible;
and e) small wrist watches with second hands. No other
jewelry and/or visible body piercing is allowed in the
clinical area. (Please don’t assume because the pierced
ornament is in your tongue that it is invisible. It is not
acceptable professional dress).
 Tattoos: No visible tattoos are permitted. Cover any
tattoos that may be visible.
Uniform
 The uniform top is light blue and includes the
monogrammed CSUB Department of Nursing logo (with
optional first name).
 This uniform’s pants are regulation type of opaque white
or light blue (the same color and fabric as the traditional
top and lab jacket) with straight leg pants (men or
women), or knee to mid-calf length skirts or culottes
(women only). Women students must wear pantyhose
with skirts. Only a regulation blue CSUB lab coat with
the CSUB monogrammed Department of Nursing logo
with optional student first name may be worn over the
uniform. Appropriate undergarments must be worn and
must be covered by the uniform. Students may opt to
wear a white T-shirt under the uniform if desired.
Uniform (cont)
 Casual attire, such as shorts, jeans, thongs, or short
midriff tops are not permissible in the clinical setting at
any time. Faculty may have additional requirements for
specific clinical areas. Please clear any exceptions to
these items with your clinical faculty.
 Students in Level III courses are assigned to community
experiences are required to wear self purchased straight
leg khaki colored slacks/pants (men or women) or knee
to mid-calf skirt (women only) with the specifically
selected CSUB nursing dark blue polo shirt ordered
through the Department of Nursing or other appointed
vendor.
Uniform (cont)
 Exceptions: Requests for exceptions must be
submitted to the faculty and/or agency in writing before
the day of the clinical experience.
 The guidelines, established by CSUB students and
faculty, will be enforced for all students in the Nursing
program. Any student failing to comply will be asked to
leave the clinical area and may not return until
modifications are made. This action will result in an
unexcused absence for the day. Any desired deviation
from this code must be presented to the Faculty for their
consideration. Students should be aware that additional
dress restrictions and infection control policies might be
required in specific departments of agencies or hospitals.
Simulation & Skills Lab
Dress Code
 These rules are designed to promote safe and efficient
use of the skills/simulation laboratory. The laboratory
setting is intended to simulate the agency environment.
The equipment in the skills/simulation lab is quite
expensive and must be treated with respect. It is
expected that behavior in the laboratory will reflect an
understanding of proper behavior in the clinical setting.
The following rules apply to individuals or groups using
the skills laboratory:
 1. Food and drink are NOT allowed in the
skills/simulation laboratory.
 2. Students must wear their CSUB identification badge,
lab coat over appropriate street clothes/shoes.
Uniforms are to be worn during assigned clinical
simulation time.
Simulation & Skills Lab
Dress Code
 3.
 4.
 5.
 6.
Students are not allowed in the skills/simulation laboratory
without faculty supervision, unless given express consent by
the Skills Lab Coordinator.
Replace chairs, bedside tables, mannequins, and beds and
privacy curtains to their proper location.
Faculty must supervise the use of equipment in the locked
cabinets. Students may use their own laboratory equipment on
scheduled lab day and by pre-arrangement with faculty. All
equipment must be returned to the area designated by the
Skills Laboratory Coordinator at the end of each laboratory
session. Faculty will supervise the return of equipment and
ensure the laboratory are locked after use.
The simulation equipment (mannequins, models) requires
gentle handling and students must be supervised by a faculty
member. The Computerized Patient Simulators are to be
handled by trained faculty ONLY.
Simulation & Skills Lab
Dress Code
 7.
 8.
 9.
 10.
 11.
 12.
Sitting or lying on the beds is prohibited, except for specified
simulation laboratory experiences. Never wear shoes while in or
on the beds. The beds are not intended for naps-- if you are
ill, go to the Student Health Center.
Report any safety or equipment problems to the faculty, Skills
Lab Coordinator or the nursing office.
Simulation exercises demand the same privacy as would be
accorded a patient in the Agency.
Trash and used disposable equipment should be placed in the
proper containers before you leave. Contaminated equipment
should be disposed of following specific policies.
Skills Laboratory equipment and supplies are for use only for
clinical lab course work.
Syringes and needles can only be used in the skills laboratory or
lecture room when faculty are available to supervise. Syringes
and needles cannot be signed out or taken out of the nursing
building by students. The supervising faculty are responsible for
the correct disposal of used syringes and needles.
Photo ID
 Photo identification badges are considered part of the uniform and
identify the wearer as a California State University, Bakersfield
student nurse. The photo identification badge must be attached to
clothing above the waist and visible at all times and may not be
attached to a lanyard.
 Replacement photo ID badges are requested in the Nursing
Department office and a fee is assessed.
 Photo ID badges must be returned to the Nursing Department office
upon completion or termination of the program.
Patient Satisfaction
 Common selections for patient satisfaction
surveys
 Pre-Admission Satisfaction
 Physician Satisfaction (Did you see your
Doctor?)
 Clinical Care (How you were treated?)
 Environment (Cleanliness?)
 Discharge
Final Thought: When Things Go Wrong –
Help Make Them Right!
 You can help turn Disappointment into
Satisfaction. First, remember to
acknowledge the customer’s complaint or
concerns. Then take action!
 Make amends. A simple apology goes a long
way toward showing our sincerity and
concern.
 Invite the customer to help solve problems.
WORKPLACE
VIOLENCE
Occupational Hazards
in Hospitals
Introduction
Today more than 5 million U.S. hospital
workers from many occupations perform
a wide variety of duties.
They are exposed to many safety and
health hazards, including violence.
We have identified the hospitals’ High
Risk Departments.
Continued …
According to estimates from the Bureau of
Labor Statistics, 2,637 nonfatal assaults
on hospital workers occurred in 2000 – a
rate of 8.3 assaults per 10,0000 workers.
This rate is much higher than the rate of
nonfatal assaults for all private-sector
industries, which is 2 per 10,000 workers.
Who is at Risk?
 Although anyone working in a hospital may
become a victim of violence, nurses and
healthcare providers who have the most
direct contact with patients are at higher risk
(i.e. ER, ICU). Other hospital personnel at
increased risk of violence include emergency
response personnel, hospital safety officers
and all health care providers and volunteers.
Violence Awareness
Education
California Health & Safety Code
1257.7 & 1257.8 requires that
hospital employee regularly assigned
to the ED and other high risk areas
receive this training.
GOALS
 Know general safety
measures.
 Know personal safety
measures.
 Understand the assault
cycle.
 Know aggression and
violence predicting
factors.
 How to obtain patient
history from patient with
violent behavior.
 Characteristics of
aggressive and violent
patients and victims.
 Strategies to avoid
physical harm.
 Restraining techniques.
 Resources available to
employees for coping
with incident of
violence.
What is
Workplace Violence?
What is
Workplace Violence?
 Workplace violence ranges from offensive
or threatening language to homicide
(including physical assaults and threats of
assaults) directed toward persons at work
or on duty.
 Statistics.
Why do People
Commit Violence?
 Stress and frustration – For example, long waiting
times or not knowing about a patient’s condition can cause
agitation.
 Revenge – For example, patients and / or their loved ones
may blame a health-card provider for an unwanted outcome. An
employee may seek revenge for not getting a desired promotion
or raise.
 Personal problems – For example, a visitor may
respond to grief by lashing out at an employee. An employee
with a substance abuse problem may use threats to pressure a
co-worker not to turn him or her in.
Continued …
 Fear or confusion – For example, a patient with a
head injury may not remember how he or she arrived at the
facility and blame staff. A visitor may respond to fear by lashing
out at those trying to help.
 Being separated from family – For example, a
patient may get upset if he or she can’t be with a loved one at all
times.
 A drug reaction – For example, a patient may become
confused or disoriented and lash out at someone without
knowing it.
Examples of Violence
Threats
Physical assaults
Muggings
Examples of Violence
 Threats: Expression of intent to cause harm,
including verbal threats, threatening body
language, and written threats.
 Physical assaults: Attacks ranging from slapping
and beating to rape, homicide, and the use of
weapons such as firearms, bombs, or knives.
 Muggings: Aggravated assaults, usually
conducted by surprise and with intent to rob.
Where may
Violence Occur?
Violence may occur anywhere in the
hospital, but it is most frequent in the
following areas.
Where may
Violence Occur?
Violence may occur anywhere in the
hospital, but it is most frequent in the
following areas:
Psychiatric wards
Emergency rooms
Waiting rooms
Geriatric units
Areas that may contain cash
What are the Effects of
Violence?
The effects of violence can range in
intensity and include the following:
Minor physical injuries.
Serious physical injuries.
Temporary and permanent physical
disability.
Psychological trauma.
Even death.
Some other Effects
of Violence?
Violence may also have negative
organizational outcomes such as lower
worker morale, increased job stress,
increased worker turnover, reduced
trust of management and coworkers,
and a hostile working environment.
What Makes a Satisfied
Customer?
H
I
SATI S F I E D
Patrons
Praisers
O
D
P
D
E
E
Walkers
Talkers
N
D I S SATI S F I E D
N
Maintain Behavior that Helps
Diffuse Anger
 Present a calm, caring attitude.
 Don’t match the threats.
 Don’t give orders.
 Acknowledge the person’s feelings (for
example “I know you are frustrated”).
 Avoid any behavior that may be interpreted as
aggressive (for example, moving rapidly,
getting too close, touching, or speaking
loudly).
Take the Heat
H
Hear them out
E
Empathize
A
Apologize
T
Take responsibility for action
What are the Risk Factors of
Violence?
The risk factors for violence vary from
hospital to hospital depending on
location, size, and type of care.
Common risk factors for hospital
violence include the following:
Working directly with volatile people, especially if
they are under the influence of drugs, alcohol or
have a history of violence or certain psychotic
diagnoses.
Continued …
 Working when understaffed - especially during meal times
and visiting hours.
 Transporting patients.
 Long waits for service.
 Overcrowded, uncomfortable waiting rooms.
 Working alone.
 Poor environmental design.
 Inadequate security.
 Lack of staff training and policies for preventing and
managing cries with potentially volatile patients.
 Drug and alcohol abuse.
 Access to firearms.
 Unrestricted movement of the public.
 Poorly lit corridors, rooms, parking lots, and other areas.
Case Reports: Prevention
Strategies That Have Worked
 A security screening system in a Detroit hospital
included stationary metal detectors supplemented by
hand-held units. The system prevented the entry of
33 handguns, 1,324 knives, and 97 mace-type sprays
during a 6-month period.
 A violence reporting program in the Portland, Oregon,
VA Medical Center identified patients with a history of
violence in a computerized database. The program
helped reduce the number of all violent attacks by
91.6% by alerting staff to take additional safely
measures when serving these patients.
Know the Aggression Cycle










High Tension
Release
Calming
Emotion
Guilt
Short Term Depression
Apologetic
Normal
Frustration
Stress
Safety Tips for
Hospital Workers
Watch for signals that may be associated
with impending violence:
Verbally expressed anger and frustration.
Body language such as threatening gestures.
Signs of drug or alcohol use.
Presence of a weapon – Code Silver (BHH,
BMH, KMC, Adventist, Mercy).
Be Alert
 Evaluate each situation for potential violence
when you enter a room or begin to relate to a
patient or visitor.
 Be vigilant throughout the encounter.
 Don’t isolate yourself with a potentially violent
person.
 Always keep an open path for exiting - don’t
let the potentially violent person stand
between and the door.
Check your Work Area
Potential weapons:
Are sharps( needles, scissors, scalpels, etc.)
safely stored and locked up?
Are heavy objects (paperweights, tools, etc.)
secure or out of sight?
Limited access areas:
Are they locked properly at all times.
Do staff wear ID badges that can be clearly
seen at all times?
Continued …
 Lighting:
 Are high-risk areas (parking lots, stairwells, etc.) kept well lit?
 Is lighting adequate in all areas of your workplace (including
parking lots)?
 Alarms and security:
 Are security alarms (including panic buttons) within easy
reach?
 Are security numbers clearly posted by all phones?
 Is the security department located in a highly visible area
that is easy for staff and visitors to get to?
 Exits:
 Are exits clearly marked?
 Are escape routes kept clear?
If Violence Strikes - Know
How to Respond Quickly
 Protect yourself first.
 Sound the alarm or warning code.
Panic Buttons
Code Green (BHH, Mercy)
Code Gray (KMC, Adventist, BMH)
Code Silver (BHH, Adventist, KMC, BMH, Mercy)
EMS 911
 Give the person what he or she wants, if you can.
 Do not try to take away the person’s weapon.
 Only use restraints as a last resort.
When it’s Time to Call for help
You are unable to defuse the situation.
The situation becomes more hostile.
Threats are being made.
Weapons are seen.
Summary
All hospital workers should be alert and
cautious when interacting with patients
and visitors. They should actively
participate in safety training programs and
be familiar with their employers’ policies,
procedures and materials on violence
prevention.